The European Association for Cardio-Thoracic Surgery (EACTS) has recently updated and published the "2024 EACTS guidelines on perioperative medication in adult cardiac surgery". Based on the latest evidence, the guidelines have been updated in multiple aspects including underlying disease management, antithrombotic medication, arrhythmia treatment and other supportive care, etc. This paper aims to summarize and interpret the guidelines, in order to promote clinicians’ understanding and optimize perioperative medical treatment in adult cardiac surgery.

Objective To observe the clinical effect of minimally invasive rotational curettage combined with water-assisted liposuction(WAL)in the treatment of gynecomastia(GYN)patients.Methods The clinical data of 80 GYN patients were retrospectively analyzed.According to different surgical methods,the patients were divided into minimally invasive surgery group(41 cases)and study group(39 cases).The minimally invasive surgery group underwent minimally invasive rotation-al curettage,while the study group underwent minimally invasive rotational curettage combined with WAL.The surgical indicators,pain intensity 24 hours postoperatively,postoperative complications,and subjective satisfaction were observed and compared between the two groups.Results The unilat-eral surgical duration in the study group was shorter than that in the minimally invasive surgery group,with a statistically significant difference(P＜0.05).No statistically significant differences were found in unilateral incision length,intraoperative blood loss,and postoperative hospital stay between the two groups(P＞0.05).No statistically significant difference was found in pain intensity 24 hours postoperatively between the two groups(P＞0.05).The incidence of postoperative complicationsin the study group was 5.13％,which was lower than 21.95％in the minimally invasive surgery group(P＜0.05).The study group had higher satisfaction scores for chest flatness without depression and breast symmetry than the minimally invasive surgery group(P＜0.05).Conclusion Compared with minimally invasive rotational curettage alone,the combination of minimally invasive rotational curet-tage and WAL for GYN patients results in shorter surgical duration,a lower incidence of postoperative complications,and higher patient satisfaction with breast appearance.

Objectives:To investigate the clinical efficacy of occipitocervical fusion with the occipital screw-rod-multiaxial screw internal fixation system in treating"sandwich"deformity with atlantoaxial disloca tion.Methods:A retrospective analysis was conducted on 62 patients who underwent posterior reduction,bone graft fusion,and occipitocervical internal fixation for"sandwich"deformity with atlantoaxial dislocation from January 2017 to January 2023.There were 19 males and 43 females,aged 51.1±23.5 years(29-72 years).The patients were divided into two groups based on the different fixation methods of the occipital screws used in the two types of occipitocervical internal fixation systems:group A of 38 patients utilized the occipital screw-rod-multiaxial screw system,consisting of 12 males and 26 females,aged 50.9±24.8 years(29-72 years),and the imaging findings revealed brainstem or cervical spinal cord compression in 30 cases,syringomyelia in 6 cases,and Chiari malformation in 2 cases;And group B of 24 cases utilized the occipital plate-rod-multiaxial screw system,consisting of 7 males and 17 females,aged 51.4±22.4 years(32-69 years),and the imaging findings revealed brainstem or cervical spinal cord compression in 16 cases,syringomyelia in 6 cases,and Chiari malformation in 2 cases.Group A was followed up for 36.5±11.8 months and Group B was followed up for 36.1±9.8 months.No statistically significant differences were observed between the two groups in terms of age,sex,imaging findings,or surgery style(P＞0.05).A comparison was performed between the groups regarding intraoperative blood loss,operative time,follow-up period,and complication rates.Clini-cal outcomes were evaluated preoperatively and at the final follow-up using the neck pain visual analog scale(VAS)score,neck disability index(NDI),and Japanese Orthopaedic Association(JOA)score.The cross-sectional and sagittal bone fusion area of the graft site,atlantodental interval(ADI),space available for cord(SAC),clivus canal angle(CCA),and cervico-medullary angle(CMA)were measured preoperatively,1 week postoperatively,and at the final follow-up in both groups.Results:Group A and group B weren't significantly different in intraoperative blood loss(362.4±89.1mL vs 345.1±93.8mL,P＞0.05)and operative time(144.8±35.6min vs 143.7±36.2min,P＞0.05).In group B,rod fractures occurred in 2 cases and loss of reduction was observed in 3 cases,whereas the remaining patients maintained stable screw-rod fixation.Neither group experienced severe complications such as spinal cord injury or cerebrospinal fluid leakage.Both groups demonstrated statistically significant differences between preoperative NDI,VAS,JOA scores and those measured at the final follow-up(P＜0.05),while no statistically significant differences existed between the two groups at the same time points(P＞0.05).Statistically significant differences were observed between preoperative and postoperative(1-week and final follow-up)measurements for ADI,SAC,CCA and CMA in both groups(P＜0.05),while no significant in-tergroup differences were found at corresponding time points(P＞0.05).In group A,the cross-sectional area and the sagittal area of the graft site were 385.44±84.51mm2 and 290.28±1 10.41mm2 in postoperative 1 week,and 267.06±66.13mm2 and 204.54±83.85mm2 at the final follow-up;which in group B were 442.61±76.85mm2 and 267.21±104.63mm2 in postoperative 1 week,and 172.43±37.37mm2 and 124.87±48.10mm2 at final follow-up.Comparisons between groups revealed no statistically significant differences in either cross-sectional or sagittal graft areas at 1 week postoperatively(P＞0.05),however,significant differences were observed at the final fol-low-up(P＜0.05)for both parameters between the two groups.Conclusions:The occipital screw-rod-multiaxial screw internal fixation system presents comparable restoration effects to the occipital plate-rod-multiaxial screw system in treating"sandwich"deformity with atlantoaxial dislocation.It exhibits satisfactory implant fusion postoperatively and achieves reliable occipitocervical fixation.

Objectives:To investigate the clinical efficacy of occipitocervical fusion with the occipital screw-rod-multiaxial screw internal fixation system in treating"sandwich"deformity with atlantoaxial disloca tion.Methods:A retrospective analysis was conducted on 62 patients who underwent posterior reduction,bone graft fusion,and occipitocervical internal fixation for"sandwich"deformity with atlantoaxial dislocation from January 2017 to January 2023.There were 19 males and 43 females,aged 51.1±23.5 years(29-72 years).The patients were divided into two groups based on the different fixation methods of the occipital screws used in the two types of occipitocervical internal fixation systems:group A of 38 patients utilized the occipital screw-rod-multiaxial screw system,consisting of 12 males and 26 females,aged 50.9±24.8 years(29-72 years),and the imaging findings revealed brainstem or cervical spinal cord compression in 30 cases,syringomyelia in 6 cases,and Chiari malformation in 2 cases;And group B of 24 cases utilized the occipital plate-rod-multiaxial screw system,consisting of 7 males and 17 females,aged 51.4±22.4 years(32-69 years),and the imaging findings revealed brainstem or cervical spinal cord compression in 16 cases,syringomyelia in 6 cases,and Chiari malformation in 2 cases.Group A was followed up for 36.5±11.8 months and Group B was followed up for 36.1±9.8 months.No statistically significant differences were observed between the two groups in terms of age,sex,imaging findings,or surgery style(P＞0.05).A comparison was performed between the groups regarding intraoperative blood loss,operative time,follow-up period,and complication rates.Clini-cal outcomes were evaluated preoperatively and at the final follow-up using the neck pain visual analog scale(VAS)score,neck disability index(NDI),and Japanese Orthopaedic Association(JOA)score.The cross-sectional and sagittal bone fusion area of the graft site,atlantodental interval(ADI),space available for cord(SAC),clivus canal angle(CCA),and cervico-medullary angle(CMA)were measured preoperatively,1 week postoperatively,and at the final follow-up in both groups.Results:Group A and group B weren't significantly different in intraoperative blood loss(362.4±89.1mL vs 345.1±93.8mL,P＞0.05)and operative time(144.8±35.6min vs 143.7±36.2min,P＞0.05).In group B,rod fractures occurred in 2 cases and loss of reduction was observed in 3 cases,whereas the remaining patients maintained stable screw-rod fixation.Neither group experienced severe complications such as spinal cord injury or cerebrospinal fluid leakage.Both groups demonstrated statistically significant differences between preoperative NDI,VAS,JOA scores and those measured at the final follow-up(P＜0.05),while no statistically significant differences existed between the two groups at the same time points(P＞0.05).Statistically significant differences were observed between preoperative and postoperative(1-week and final follow-up)measurements for ADI,SAC,CCA and CMA in both groups(P＜0.05),while no significant in-tergroup differences were found at corresponding time points(P＞0.05).In group A,the cross-sectional area and the sagittal area of the graft site were 385.44±84.51mm2 and 290.28±1 10.41mm2 in postoperative 1 week,and 267.06±66.13mm2 and 204.54±83.85mm2 at the final follow-up;which in group B were 442.61±76.85mm2 and 267.21±104.63mm2 in postoperative 1 week,and 172.43±37.37mm2 and 124.87±48.10mm2 at final follow-up.Comparisons between groups revealed no statistically significant differences in either cross-sectional or sagittal graft areas at 1 week postoperatively(P＞0.05),however,significant differences were observed at the final fol-low-up(P＜0.05)for both parameters between the two groups.Conclusions:The occipital screw-rod-multiaxial screw internal fixation system presents comparable restoration effects to the occipital plate-rod-multiaxial screw system in treating"sandwich"deformity with atlantoaxial dislocation.It exhibits satisfactory implant fusion postoperatively and achieves reliable occipitocervical fixation.

The prevalence of diabetes mellitus in China has recently been increasing year by year,and spontaneous skin ulcers in diabetic patients,as one of the most serious complications,often develop on the patient's extremities represented by foot ulcers.Due to the complexity and variety of its pathogenesis,it leads to poor clinical outcomes and difficulty in healing.Thus,pa-tients often face the risk of amputation and death.Therefore,the exploration of mechanisms of the vascular pathogenesis of diabetic delayed-healing wounds and targeted screening of therapeutic agents has become a current research hotspot.Herein,in this paper,we briefly review the role of impaired angiogenesis and vascular dysfunction in diabetic skin ulcers,and the research progress of classical hypoglycemic and natural compounds against vascular lesions is preliminarily summarized to provide a theoretical basis for effective clinical treatment.

ObjectiveTo investigate the expression of lysophosphatidic acid （LPA） in patients with liver cancer， as well as its influence on malignant biological behavior of liver cancer and related regulatory mechanism. MethodsFrom January 2016 to December 2022， 26 patients with liver cancer， 28 patients with liver cirrhosis， and 28 individuals undergoing physical examination were enrolled. ELISIA was used to measure the content of LPA in plasma and peritoneal effusion of the patients with liver cancer or liver cirrhosis accompanied by peritoneal effusion， and the content of LPA was measured in plasma of the normal population at the same time， so as to clarify the difference in the expression of LPA in different populations， such as the patients with liver cancer and those with liver cirrhosis. MTT cell proliferation assay and cell migration assay were used to observe the influence of LPA and its inhibitor pertussis toxin （PTX） on the proliferation， migration， and invasion of SMMC7721 cells. In order to investigate the effect of LPA on the expression of RhoA and its upstream and downstream molecules FAK and P53 after binding to its receptor， qPCR and Western blot were used to observe the effect of LPA on the mRNA and protein expression levels of P53， FAK， and RhoA in SMMC7721 cells. A one-way analysis of variance was used for comparison of the means of continuous data between multiple groups， and the SNK-q test was used for comparison between two groups. ResultsCompared with the patients with liver cirrhosis， the patients with liver cancer had a significantly higher concentration of LPA in plasma （4.99±0.55 μmol/L vs 2.63±0.43 μmol/L， P<0.05） and peritoneal effusion （5.19±0.63 μmol/L vs 2.91±0.46 μmol/L， P<0.05）， and the patients with liver cancer also had a significantly higher level of plasma LPA than the normal population （4.99±0.55 μmol/L vs 1.61±0.39 μmol/L， P<0.05）. The cell proliferation assay showed that LPA significantly promoted the proliferation of SMMC7721 cells， and cell proliferation rate increased with the increase in dose and time； in particular， the middle-and high-dose groups had a significantly higher proliferation rate than the control group （P<0.05）. PTX inhibited the proliferative capacity of SMMC7721 cells in a time-dependent manner， and there was a significant difference between the groups （P<0.05）. The proliferation rate of the 72-hour high-dose LPA group was 3.6 times that of the control group， while the proliferation rate of the PTX group was 0.6 times that of the control group； the proliferation rate of the 72-hour high-dose LPA+PTX group was 1.2 times that of the control group. In addition， LPA increased the migration ability of hepatoma cells， while PTX inhibited their migration， in a time-dependent manner， and there was a significant difference between the groups （P<0.05）. The migration rate of the 72-hour high-dose LPA group was 3.09 times that of the control group， while the migration rate of the PTX group was 0.4 times that of the control group； the migration rate of the 72-hour high-dose LPA+PTX group was 0.99 times that of the control group. qPCR and Western blot showed that there were significant reductions in the mRNA and protein expression levels of P53 in SMMC7721 cells after LPA treatment， while there were significant increases in the mRNA and protein expression levels of FAK and RhoA； there was a significant difference between the LPA group and the control group （P<0.05）. ConclusionThere is an abnormal increase in the expression of LPA in patients with liver cancer， and LPA can promote the proliferation of liver cancer cells and increase their migration ability. At the same time， LPA changes the expression levels of P53， FAK， and RhoA， which may be associated with the promotion of tumor development and progression by LPA.

Objective:To evaluate the safety and efficacy of ciprofol and propofol for gynecological surgeries with general anesthesia through a meta-analysis.Methods:Electronic databases including PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, Wanfang Data, China Biomedical Literature Database, and China Science and Technology Journal Database were searched for randomized controlled trials comparing the safety and efficacy of ciprofol and propofol in gynecological surgeries with general anesthesia from inception to May 2023. Meta-analysis was performed using Revman 5.4 software.Results:Six randomized controlled trials were included, involving 741 patients, of which 371 received ciprofol and 370 received propofol. Compared with propofol group, the emergence time was significantly prolonged, the difference in mean arterial blood pressure, systolic blood pressure and diastolic blood pressure before and after anesthesia induction was decreased, and the incidence of injection pain, respiratory depression, body movement and hypotension was decreased in ciprofol group ( P<0.05). There were no significant differences between the two groups in terms of time of successful anesthesia induction, difference in BIS values and heart rate before and after anesthesia induction, and incidence of tachycardia, bradycardia and hypertension ( P>0.05). Conclusions:Ciprofol is comparable to propofol in terms of efficacy and has better safety than propofol when used in gynecologic surgeries with general anesthesia.

Neural crest-derived mesenchymal stem cells (MSCs) are known to play an essential function during tooth and skeletal development. PRX1⁺ cells constitute an important MSC subtype that is implicated in osteogenesis. However, their potential function in tooth development and regeneration remains elusive. In the present study, we first assessed the cell fate of PRX1⁺ cells during molar development and periodontal ligament (PDL) formation in mice. Furthermore, single-cell RNA sequencing analysis was performed to study the distribution of PRX1⁺ cells in PDL cells. The behavior of PRX1⁺ cells during PDL reconstruction was investigated using an allogeneic transplanted tooth model. Although PRX1⁺ cells are spatial specific and can differentiate into almost all types of mesenchymal cells in first molars, their distribution in third molars is highly limited. The PDL formation is associated with a high number of PRX1⁺ cells; during transplanted teeth PDL reconstruction, PRX1⁺ cells from the recipient alveolar bone participate in angiogenesis as pericytes. Overall, PRX1⁺ cells are a key subtype of dental MSCs involved in the formation of mouse molar and PDL and participate in angiogenesis as pericytes during PDL reconstruction after tooth transplantation.
Animals ; Cell Differentiation ; Mesenchymal Stem Cells ; Mice ; Molar ; Osteogenesis/physiology* ; Periodontal Ligament

In vitro studies have established the prevalent theory that the mitochondrial kinase PINK1 protects neurodegeneration by removing damaged mitochondria in Parkinson's disease (PD). However, difficulty in detecting endogenous PINK1 protein in rodent brains and cell lines has prevented the rigorous investigation of the in vivo role of PINK1. Here we report that PINK1 kinase form is selectively expressed in the human and monkey brains. CRISPR/Cas9-mediated deficiency of PINK1 causes similar neurodegeneration in the brains of fetal and adult monkeys as well as cultured monkey neurons without affecting mitochondrial protein expression and morphology. Importantly, PINK1 mutations in the primate brain and human cells reduce protein phosphorylation that is important for neuronal function and survival. Our findings suggest that PINK1 kinase activity rather than its mitochondrial function is essential for the neuronal survival in the primate brains and that its kinase dysfunction could be involved in the pathogenesis of PD.

ObjectiveTo study the effect of Buyang Huanwutang on Kelch-like Ech-related protein 1 （Keap1）/nuclear factor E₂-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） antioxidant signaling pathway in rats with idiopathic pulmonary fibrosis （IPF） and explore the mechanism of this prescription in the treatment of IPF. MethodForty SPF-grade male SD rats were assigned into a sham operation group， a model group， a Buyang Huanwutang group， and a nintedanib group according to random number table method， with 10 rats in each group. IPF rat model was established by intratracheal infusion of bleomycin （0.005 g·kg^-1） in other groups except the sham operation group. Buyang Huanwutang group was administrated with Buyang Huanwutang (14.84 g·kg^-1)，intragastric administration of nitedanib suspension (0.1 g·kg^-1)，sham operation group and model group were given equal volume of normal saline， for 28 days. After lung function test， serum and lung tissue samples were collected. Hematoxylin-eosin （HE） staining and Masson trichrome staining were employed to observe the pathological changes of the lung tissue. The content of hydroxyproline （HYP） in lung tissue was detected. The levels of malondialdehyde （MDA） in serum and lung tissue， and the activities of superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px） and catalase （CAT） were determined. The mRNA and protein levels of Keap1， Nrf2， and HO-1 was determined by Real-time fluorescent quantitative polymerase chain reaction， immunohistochemical staining， and Western blot. ResultCompared with the sham operation group， the modeling increased the resistance and elasticity and decreased the compliance of respiratory system （P<0.01）， elevated the lung index， pathological score， and HYP content in lung tissue （P<0.01）， and enriched MDA in serum and lung tissue， while it decreased the activities of SOD， GSH-Px， and CAT （P<0.01）. Furthermore， the modeling down-regulated the mRNA and protein levels of Keap1 and up-regulated those of Nrf2 and HO-1 in lung tissue （P<0.01）. Compared with the model group， Buyang Huanwutang decreased the resistance and elasticity and increased the compliance of respiratory system （P<0.01）， lowered the lung index， pathological score， and HYP content in lung tissue （P<0.01）， and reduced MDA in serum and lung tissue， while it increased the activities of SOD， GSH-Px， and CAT （P<0.01）. Additionally， Buyang Huanwutang down-regulated the expression of Keap1 and up-regulated that of Nrf2 and HO-1 in lung tissue （P<0.05， P<0.01）. ConclusionBuyang Huanwutang can activate Keap1/Nrf2/HO-1 signaling pathway to enhance the antioxidant capacity and slow down the pathological process of IPF in rats.